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Post-cholecystectomy Diarrhoea or Bile Dumping Syndrome Dumping syndrome is a relatively rare disorder in which the stomach's contents are delivered too quickly to the small intestine.

It is a physiological reaction to the consumption of too much simple or refined sugar. The stomach serves as a reservoir that releases food downstream only at a controlled rate, avoiding sudden large influxes of sugar. Besides, the released food is also mixed with stomach acid, bile, and pancreatic juice to control the chemical makeup of the stuff that goes downstream and avoid all the side effects.

Dumping syndrome classically develops after gallbladder surgery, although it may also occur after other abdominal operations, such as ulcer surgery, surgery for severe reflux, the removal of the stomach or stomach bypass surgery (to lose weight). Less frequently, it may be seen in people born with unusually small stomachs and, even more rarely, in those with no stomach abnormalities at all.

Making diet changes can be useful in preventing dumping syndrome. The following guidelines are recommended to prevent foods from being emptied from the stomach into the intestines too quickly

1. Go for the intake of complex carbohydrates, plus protein and fat to ensure a slow emptying of the stomach. Eat protein rich foods first at each meal to help you maintain your lean body mass as you lose weight. Aim for 60 grams of protein per day.

3. Limit concentrated sugars like cookies, cake, pies, bread, sugar, and syrup. Watch out for high calorie liquids such as regular soda, presweetened iced tea, fruit juices, and alcoholic beverages. If these foods are consumed, try to limit them to no more than 2 cups per day.

Other foods, such as ice cream and potato chips should also be avoided for this same reason. All of these foods may also cause dumping syndrome.

9. Lie down for 15 to 20 minutes after a meal to slow the movement of food from the stomach to the intestines.

Late dumping

Late dumping occurs 1-3 hours after a meal. The pathogenesis is thought to be related to the early development of hyperinsulinemic (reactive) hypoglycemia. Rapid delivery of a meal to the small intestine results in an initial high concentration of carbohydrates in the small bowel and rapid absorption of glucose. This is countered by a hyperinsulinemic response.

The high insulin levels stay for longer period and are responsible for the subsequent hypoglycemia. This effect of enhanced insulin release after an enteral glucose load as compared to intravenous glucose administration is called the incretin effect.

Two hormones are thought to play a pivotal role in the incretin effect. These are glucose-dependent insulinotropic peptide and GLP-1. In human studies, an increase in GLP-1 response has been noted after an oral glucose challenge. An increased GLP-1 response has been noted in patients after total gastrectomy, oesophageal resection, and partial gastrectomy. Furthermore, a positive correlation was found between the rise in plasma GLP-1 and insulin release.

An exaggerated GLP-1 response likely plays an important role in the hyperinsulinemia and hypoglycemia in patients with late dumping.